Application of prothrombin complex concentrate for reversal of direct oral anticoagulants in clinical practice: indications, patient characteristics and clinical outcomes compared to reversal of vitamin K antagonists

BackgroundProthrombin complex concentrate (PCC) is widely used to reverse the action of direct oral anticoagulants (DOACs) in accordance with current guidelines and because of a lack of specific reversal agents. Indications, clinical characteristics and patient outcomes of patients might differ in comparison to reversal of vitamin K antagonists where reversal with PCC is well established.MethodsOur cohort study explores patient characteristics, indications and clinical outcomes for reversal of all DOAC patients receiving PCC at our university emergency department from 01.06.2012 to 01.07.2017, in comparison with patients on VKA.ResultsOut of 199,982 consultations, we studied 346 patients who were given PCC for reversal of either DOAC (n=74) or VKA (n=272). The most common reason for treatment was acute bleeding; in 86.7% of both groups. 37.3% of bleeding was traumatic (p=0.666). The most frequent bleeding location was intracranial (61.6%, p=0.881). Gastrointestinal bleeding was more often found in the DOAC group (18.9% vs. 8.8%, p=0.014). More erythrocyte concentrates (ECs) were given to DOAC patients with blood transfusion (p=0.014). Tranexamic acid was used more often in DOAC patients than in VKA patients (28.4% vs. 7.4%, p